A Young Couple
I had a young couple come into clinic last week. The husband worked as a machinist. He was good at his job and in high demand. The wife stayed at home to care for their two young children.
The husband had been experiencing back pain after hearing a pop in his lower back while reaching down for a tool. He was experiencing low back pain on a daily basis. No matter what he did, he could not get rid of his pain. He was sleeping very poorly and rated himself as an 8 out of 10 on anxiety, depression, and irritability. His wife’s comments made it clear that he was not in a good mood when he came home from work every evening.
His Spine was Fine
His MRI scan showed some mild degeneration in several discs in his lower back. However, it has been well documented that degenerated discs do not cause chronic low back pain. The patient’s spine was fine. There were no structural problems found on any test. In this kind of case, when a surgical fusion or artificial disc is performed, the success rate is less than 30%. This kind of back pain is not reliably solved with surgery.
His Prognosis was Excellent
The patient also had migraine headaches and irritable bowel syndrome. This got me excited, because it suggested the patient had a textbook case of Mind Body Syndrome, which is a very solvable problem. I was also happy that his spine looked better than most people for his age and activity level. His chances of returning to full function without medications were extremely high—with engagement in the DOCC Project, of course.
I carefully explained to him that, structurally, his spine looked quite good and that he did not need surgery. I spent about 10 minutes showing him this website, explaining how to begin the process of healing. I referred him to a pain physician that uses slightly different tools but relies on the same Mind Body principles to which I prescibe.
“The Pain is Not in My Head”
Suddenly he said, “This is not what I expected. You are telling me that the pain I am experiencing is in my head.” He then went into a detailed explanation about how real his pain was.
Pain is Always in Your Head
I explained to him that the experience of pain is only in your brain. It does not matter why the pain pathways are firing. If they are firing, you will experience pain. Research studies have consistently demonstrated that stimulating the area of the brain that correlates to a painful body part is sufficient for causing the experience of pain in that body part. Sometimes there is an identifiable source for the pain, but sometimes there is not. In the spine world, when there is no structural problem, back surgery just makes the pain worse.
A Typical Conversation
The rest of this conversation is one I have had now with several thousand patients. Below is an almost word-for-word facsimile of a conversation I have all the time.
The patient says, “I don’t want surgery. I am happy to hear that surgery does not have to be done. I just want my pain to go away. I have tried every other possible treatment.” The patient then lists all of the treatments he or she has tried.
I reply, “You have been in pain for a long time and nothing has worked. We (my colleagues and I) are pretty excited because your kind of pain, which is very real, is solvable. We have seen many patients with your problem experience a major decrease in their pain, sometimes having it disappear altogether. You can achieve similar results, but the results depend on how committed you are to engaging in the tools we offer, namely those of the DOCC Project.”
The patient then says, “You mean to tell me that the pain is in my head. I am telling you that this is REAL pain and it is destroying my life. You aren’t me, and you just don’t understand how severe this pain is.”
I say, “I know from first hand experience that your pain is real. I have experienced chronic pain in the form of severe burning in my feet and frequent disabling migraines. I also know from first hand experience that the DOCC Project tools are effective in treating chronic pain. I learned these Mind Body strategies. Now, my burning is gone, and I no longer have migraines.”
Why Can’t You Hear Me?
When I had this conversation with the machinist, it was like he refused to hear me. We spoke in circles. After my usual explanations, he said, “The pain I am having is real. I just want to be fixed. You are a surgeon. There must be something else that can be done to take away my pain.” I had already admitted that his pain was real. I had already told him that surgery wasn’t an option. I had already told him that the DOCC Project offered him a good chance of relieving him of his pain. I was becoming exasperated. I said, “You don’t want surgery, and it is not an option anyway. The option I am offering has a high chance of success. What more do you want from me?”
He launched into the same tirade except that now he was yelling.
By the time I repeated essentially the same conversation for the third time, he was so angry that he just walked out the door. I felt terrible. Could I have presented my treatment options in a better way?
I watch patients engage treatments utilizing Mind Body principles and experience major shifts in their pain and life. I also observe other patients that refuse to engage in the DOCC Project and continue to suffer. When I was with the machinist, I felt like I was watching a patient walk off of a cliff.
The DOCC Project, or any other structured program, is not a magic bullet. It is not even a formula. It is just a framework to learn about pain so that you can take the responsibility to solve your pain problem. Every patient has a different pathway back to health. You have to be open to learning.
When I encounter noncompliant patients like this one, I really do feel bad. It is not just his life that is affected by him being closed to new ideas. His pain creates major havoc for his wife and children. His children are going to school with your children. There is a huge ripple effect. With 116 million people in the US suffering from chronic pain, the societal impact is enormous.
Pain causes extreme frustration and anger. Anger detaches you from your immediate environment. It also shuts and bolts the door to moving forward. I am continually challenged to figure out ways to unlock and open this door. It is the one area that I have no more insight on then when this project began 10 years ago.
The only thing I have learned is that I am upsetting these patients. Now, I simply give them material to read and I no longer engage in this conversation.
I am open for suggestions.
One of my Patient’s Reponse to this Post
The day I put this post on the web, one of my patients sent me this response. She is someone that has fully engaged in the Mind Body tools and has had an extraordinary journey back to full health. However, it took her a while to engage. What is impressive about her story is the amount of adversity that she has overcome to get where she is now. I will tell her story in the near future.
On your last post.
This is a difficult position for you and your patients. You need to hire one of you’re patients whose life has been changed by this process to be an advocate for your new patients.
In reality, by the time patients get to you they have been cheated, lied to, and treated like crap by other doctors. So they are just looking at another doctor that they can’t trust (until they learn better). The fact that you have been there helps, but you’re still a doctor. To someone who has spent time in the health care system that’s a dirty word.
Just my opinion. Have a wonderful Father’s Day!